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Title: Minimally-Invasive Aortic Valve Bypass Benefits High-Risk Elderly Patients
URL: http://www.pslgroup.com/dg/22CC2A.htm
Doctor's Guide
September 18, 2008

BALTIMORE -- September 18, 2008 -- Aortic valve bypass is an effective treatment option for high-risk elderly patients with aortic stenosis, according to a study published early online and in the September 30 issue of Circulation.

Surgeons at the University of Maryland Medical Center, Baltimore, Maryland, have refined the apicoaortic conduit procedure by using a small, 3-inch opening between the ribs, versus the larger opening that is usually required.

"We are excited because for the first time we can surgically treat a narrowed aortic valve through a minimally-invasive approach with the heart beating, compared to the traditional breastbone-splitting approach," said principal investigator, James S. Gammie, MD, University of Maryland School of Medicine and University of Maryland Medical Center.

"Because of the possible risks associated with aortic valve replacement in the elderly, almost 60% of patients with symptoms related to aortic stenosis are never referred to surgery,"

Survival for these patients without surgery is poor with only 20% surviving 3 years after diagnosis. "But our research and 5 years of experience with the bypass procedure suggests there is a group of patients, typically considered inoperable because they are at the upper level of the risk spectrum, who could benefit from aortic valve bypass," he said.

Between 2003 and 2007, the surgeons treated 31 high-risk aortic stenosis patients (average age 81 y) with aortic valve bypass surgery. Many of the patients also had other conditions ranging from chronic obstructive pulmonary disease to kidney disease, or had a history of heart attack or diabetes.

Nearly half of the patients had been refused conventional surgery. Early in the series, 4 of the 31 patients did not survive the procedure, yet there were no deaths among the most recent 16 consecutive patients.

The procedure was as effective as conventional aortic valve replacement surgery at relieving the obstruction of blood leaving the heart. Stroke and kidney problems were uncommon.

Because the impaired aortic valve was left in place, some blood flow continued through that valve. But postsurgical blood flow measurements indicated that in most patients, approximately 70% of cardiac output flowed through the new bypass.

The study results suggest that continued improvements in technology and surgical technique may warrant extending aortic valve bypass surgery to moderate-risk patients with aortic stenosis.


SOURCE: University of Maryland Medical Center

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